Provider Demographics
NPI:1356349443
Name:CLOTHIER, KIMBERLEY (PA)
Entity type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:
Last Name:CLOTHIER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 N OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-3404
Mailing Address - Country:US
Mailing Address - Phone:316-942-4519
Mailing Address - Fax:316-262-4887
Practice Address - Street 1:3715 N OLIVER ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220
Practice Address - Country:US
Practice Address - Phone:316-942-4519
Practice Address - Fax:316-942-4655
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS042538363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant